Raising Medicare eligibility is not the way to curb costs

‘Older Americans insured via work has dropped to 65%.’

Guest Column: Joan Retsinas

From 65 to 67. Only two years. What’s the big deal? Candidate Romney, who just turned 65, has proposed upping the age of Medicare eligibility from 65 to 67 – a “cut-federal-spending” initiative that reflects his business savvy.

Raising Medicare eligibility is not the way to curb costs

‘Older Americans insured via work has dropped to 65%.’

Posted:
Saturday, May 26, 2012 12:35 am

Guest Column: Joan Retsinas

From 65 to 67. Only two years. What’s the big deal? Candidate Romney, who just turned 65, has proposed upping the age of Medicare eligibility from 65 to 67 – a “cut-federal-spending” initiative that reflects his business savvy.

On the surface, this sounds almost reasonable. The Social Security Administration has delayed the onset of eligibility for Social Security stipends; why not follow suit with Medicare? U.S. Sens. Joseph Lieberman, I-Conn., and Tom Coburn, R-Okla., have proposed just that. Budget analysts, keen to cut spending, have put a two-year delay on the proverbial table of choices.

But a swathe of the 58 million “boomers,” ages 50-64, would suffer. Many are not so fortunate as Candidate Romney. They are not so wealthy. They are not so well-insured. And they are not so eager to defer Medicare. Indeed, they have been awaiting Medicare. Instead, Republicans would give them a card marked “delay.” It is of course better than a pink slip.

In 2010, 8.9 million of these boomers were uninsured, up from 3.7 million in 2000. The plight was worse for Hispanic and African American boomers: one in three of the former, one in five of the latter had no insurance. Although 60 percent of this age-cohort worked, they weren’t insured through their workplaces. The employee worked part-time, was a temporary worker, couldn’t afford the premium – or the employer did not offer coverage. Whatever the reason, the percentage of employed “older Americans” insured via work has dropped from 71 percent to 65 percent since 2000.

Insurers in this market are selective. They can reject applicants who are bad risks; and the illnesses that grow more frequent with age constitute bad risks.

The AARP found that insurers rejected more than 20 percent of applications from “older Americans.” Furthermore, since states let insurers factor age and health into premiums, enrollees in their early 60s paid almost twice as much as younger ones.

The impact on family budgets is not surprising: more than one in three older Americans spent more than 10 percent on health care. Half of poor older Americans spent more than 10 percent on health care.

Ironically, for older Americans, the recently passed Affordable Care Act will come to their rescue, relieving their burden. Consider the act’s provisions. Starting in 2014, insurers must accept every applicant, regardless of medical condition. While insurers will still factor age into the premium, the insurers will face limitations on pricing. Poor, uninsured Americans, whether or not they have dependent children, will be eligible for Medicaid. The state exchanges will insure others in this group. The AARP estimates that 7.3 million of the 8.9 million uninsured people ages 50 – 64 could be covered through either the exchanges or Medicaid.

Under the Affordable Care Act, the nation could still up Medicare eligibility to age 67; the option deserves discussion. The Kaiser Family Foundation, however, recently ran the numbers: the savings to Medicare would be offset to some extent by the increase in costs of Medicaid and the exchanges. •

Joan Retsinas is the managing editor of Medicine & Health/Rhode Island, a monthly journal of the Rhode Island Medical Society.

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